BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
1200 (Leno)
Hearing Date: 5/27/2010 Amended: 4/28/2010
Consultant: Katie Johnson Policy Vote: Health 5-0
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BILL SUMMARY: SB 1200 would require the Department of Managed
Health Care (DMHC) and the California Department of Insurance
(CDI) in their timely access regulations to consider timely
access to care for schoolage children who must receive medically
necessary services during school hours.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
DMHC regulations $30 - $60 $115 -
$175 $25 ongoing Special*
Potential increased CalPERS, likely low millions of dollars
annually General**
Medi-Cal, and Healthy commencing January 1, 2012,
uponFederal/
Families premiums completion of regulationsOther
*Managed Care Fund
**CalPERS: 55 percent General Fund and 45 percent other funds
Medi-Cal: 50 percent General Fund and 50 percent federal funds
Healthy Families: 65 percent General Funds and 35 percent
federal funds
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STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
This bill would require DMHC and CDI's timely access regulations
to consider timeliness of care for schoolage children who must
receive medically necessary services during school hours as an
indicator of timely access to services. If DMHC needed to update
its regulations, costs could be approximately $30,000 - $60,000
in FY 2010-2011, up to $115,000 - 175,000 in FY 2011-2012, and
$25,000 in FY 2012-2013 and ongoing. This set of regulations
would likely involve not only health care and insurance market
experts, but would also need significant input from education
experts and the California Department of Education (CDE). Any
costs to CDI would be minor and absorbable.
It is impossible to predict the final form of the regulations
and their fiscal impact on health care service plans, health
insurers, Medi-Cal managed care plans, school districts, and
county offices of education. However, discussions and
considerations could include, 1) Do the current timely access
regulations already cover timely access to medically necessary
services during the school day? 2) What services are included in
medically necessary services? 3) For which aspects of
school-based health care would the carrier and the school
district each be responsible? 4) Mechanically, how would
carriers reimburse school districts as health care providers? 5)
Would the reimbursement scheme be compulsory and standardized
statewide?
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SB 1200 (Leno)
If the established regulations resulted in a requirement that
carriers were required to reimburse local education agencies
(LEAs) for specific services provided to students during school
hours, there could be increased costs to Medi-Cal managed care
plans and to other carriers to the extent they would not be
reimbursing such services now. Medi-Cal managed care payments
are shared 38 percent General Fund and 62 percent federal funds
until December 31, 2010, and will be shared at 50 percent
General Fund and 50 percent federal funds thereafter. Healthy
Families costs are shared 35 percent neral Fund and 65 percent
federal funds.
Also, to the extent that school districts and county offices of
education were to receive General Fund and federal and private
funds as described above, a district or county office of
education could choose to use those new monies to either
supplement or supplant their existing health care services
expenditures.
Additionally, the Department of Health Care Services (DHCS)
operates the Local Education Agency (LEA) Program, outside of
the Medi-Cal managed health care system, that permits school
districts and county offices of education to be reimbursed by
the federal government through a certified public expenditure
(CPE) process for services rendered to Medi-Cal eligible
children with Independent Education Plans (IEPs) and a few other
services under specified conditions. The costs are shared 50
percent county/school district funds and 50 percent federal
funds. If school districts and county offices of education were
able and decided to claim more funds from the Medi-Cal LEA
program as a result of this bill, there could be an increased
federal fund cost. However, those federal funds would be part of
the federal Medicaid entitlement; there is no limit provided an
appropriate non-federal share is paid.
The proposed amendments would require that CDI and DMHC's timely
access regulations require plans and insurers to work
constructively with local education agencies to provide
reimbursement for covered health care services provided to a
child by the agency during school hours and to ensure adequate
availability of licensed health care professionals to
accommodate the necessary medical needs of children during
school hours, including the administration of medically
necessary medications. The amendments would also require the
departments to update existing regulations to reference this
paragraph no later than January 1, 2012.
To the extent that plans and insurers would reimburse school
districts for services rendered to members for which they
currently do not pay, premiums could increase for private plans
and insurers and for the California Public Employees Retirement
System (CalPERS), Medi-Cal Managed Care plans, and plans that
contract with the Healthy Families Program. Services to children
with IEPs and Section 504 plans would be the most likely
services that would be reimbursed. The actual services eligible
for reimbursement and the rate of reimbursement would be
determined by the regulations or agreements between the payers
and local education agencies.
While state costs are unknown and would depend on the amount of
funds that public plans and insurers would pay to local
education agencies, CalPERS costs could
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SB 1200 (Leno)
potentially be in the low millions of dollars in total funds and
would be shared 55 percent General Fund and 45 percent other
funds.
There is the potential for increased costs to Medi-Cal and
Healthy Families, but many of the children with special health
care needs are also enrolled in the California Children's
Services (CCS) program, which is responsible for reimbursing
providers for care associated with a CCS condition. These
conditions include diabetes, severe asthma, spina bifida, and
cerebral palsy. Medi-Cal managed care and Healthy Families would
not likely need to reimburse local education agencies for costs
associated with treating a CCS condition. CCS would be
responsible for the payment of providers and would not be
subject to this bill. However, if Medi-Cal managed care plans
and Healthy Families plans were to incur costs related to this
bill, they would be shared 50 percent General Fund and 50
percent federal funds for Medi-Cal and 65 percent General Funds
and 35 percent federal funds for Healthy Families.
.